Student ______________________________________________________ Instructor ____________________________________________________

PERFORMANCE CHECKLIST SKILL 7-2

Date _________________________ Date _________________________

CARING FOR PATIENTS UNDER ISOLATION PRECAUTIONS

S
ASSESSMENT

NP

Comments

1. Reviewed precautions for patients specific isolation category. 2. Reviewed appropriate laboratory test results. 3. Considered types of care to be delivered to patient. 4. Determined patients understanding of purpose of isolation and procedures. 5. Determined if patient is allergic to latex.
NURSING DIAGNOSIS

1. Developed appropriate nursing diagnoses based on patients isolated status.

PLANNING

1. Identified expected outcomes.

IMPLEMENTATION

1. Performed hand hygiene. 2. Prepared equipment and supplies. 3. Determined appropriate barriers to apply. 4. Prepared for entrance into isolation room. a. Applied isolation gown correctly, and secured ties at neck and waist. b. Applied surgical mask or respirator securely over nose and mouth. c. Applied eyewear or goggles, if needed, to fit snugly around face and eyes. d. Applied disposable gloves with edges overlying gown cuffs. 5. Entered patients room. Arranged supplies and equipment. 6. Explained purpose of isolation and necessary precautions to patient and family. 7. Assessed for emotional response to isolation precautions.

Mosby items and derived items 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published.

S 8. Assessed vital signs: a. Disinfected reusable removing from room. equipment after

NP

Comments

b. Returned stethoscope to clean surface, and cleansed diaphragm/bell with alcohol as needed. c. Used individual or disposable thermometer. 9. Administered medications: a. Gave oral medication in wrapper or cup. b. Properly disposed of wrapper or cup. c. Administered injection while wearing gloves. d. Discarded syringe and needle in proper receptacle. e. Placed reusable syringe on clean towel for removal. 10. Administered hygiene: a. Prevented isolation gown from becoming wet. b. Assisted in removing patients gown, and disposed of it appropriately. c. Removed linen from bed, and disposed of linen appropriately. d. Provided clean linen and towels. e. Changed gloves, if necessary. Performed hand hygiene. 11. Collected specimens: a. Placed specimen containers on clean paper towel in bathroom. b. Followed procedure for specimen collection. c. Transferred collected specimen to appropriate container without contaminating containers outer surface. Transferred specimens correctly into plastic bag and applied label. d. Checked label for accuracy. Sent specimen to laboratory. 12. Disposed of linen and trash bags: a. Used appropriate bags for soiled articles. b. Tied bags securely.

Mosby items and derived items 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published.

S 13. Removed all reusable equipment and disinfected contaminated surfaces. 14. Re-supplied room as needed, with another caregiver handling supplies at door. 15. Left isolation room: a. Removed gloves by turning them inside out, thereby avoiding contact with contaminated surfaces. b. Removed eyewear or goggles. c. Untied neck strings of gown. Allowed gown to fall from shoulders. Pulled gown off correctly and discarded in appropriate receptacle. d. Untied and removed mask. Disposed of mask. e. Performed hand hygiene. f. Picked up wristwatch and stethoscope before leaving room and recorded vital signs. g. Determined patients needs before leaving room. h. Left room and closed door.
EVALUATION

NP

Comments

1. While in room, determined if patient was offered an opportunity to discuss health problems, course of treatment, and related concerns. 2. Identified unexpected outcomes.
RECORDING AND REPORTING

1. Documented procedures, education performed or reinforced, and patients responses to social isolation and education.

Mosby items and derived items 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published.